<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user.user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="{$row.user_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ware_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ware_id" data-rule="required" data-source="ware/index" class="form-control selectpage" name="row[ware_id]" type="text" value="{$row.ware_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Product_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-product_id" data-rule="required" data-source="product/index" class="form-control selectpage" name="row[product_id]" type="text" value="{$row.product_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Clause_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-clause_id" data-rule="required" data-source="clause/index" class="form-control selectpage" name="row[clause_id]" type="text" value="{$row.clause_id}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ware_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ware_name" class="form-control" name="row[ware_name]" type="text" value="{$row.ware_name}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_no" class="form-control" name="row[order_no]" type="text" value="{$row.order_no}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refundtime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refundTime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[refundTime]" type="text" value="{:$row.refundTime?datetime($row.refundTime):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Visittime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-visitTime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[visitTime]" type="text" value="{:$row.visitTime?datetime($row.visitTime):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Returnvisitstatus')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-returnVisitStatus" class="form-control" name="row[returnVisitStatus]" type="text" value="{$row.returnVisitStatus}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Guaranteetype')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-guaranteeType" class="form-control" name="row[guaranteeType]" type="text" value="{$row.guaranteeType}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Guaranteeterm')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-guaranteeTerm" class="form-control" name="row[guaranteeTerm]" type="text" value="{$row.guaranteeTerm}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Orderstatus')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-orderStatus" class="form-control" name="row[orderStatus]" type="text" value="{$row.orderStatus}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Benefitinfo')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-benefitInfo" class="form-control " rows="5" name="row[benefitInfo]" cols="50">{$row.benefitInfo}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Insuredersjson')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <dl class="fieldlist" data-name="row[insuredersJson]">
                <dd>
                    <ins>{:__('Key')}</ins>
                    <ins>{:__('Value')}</ins>
                </dd>
                <dd><a href="javascript:;" class="btn btn-sm btn-success btn-append"><i class="fa fa-plus"></i> {:__('Append')}</a></dd>
                <textarea name="row[insuredersJson]" class="form-control hide" cols="30" rows="5">{$row.insuredersJson}</textarea>
            </dl>


        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Mechanid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mechanId" class="form-control" name="row[mechanId]" type="text" value="{$row.mechanId}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Orderid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-orderId" class="form-control" name="row[orderId]" type="text" value="{$row.orderId}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Policy_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-policy_no" class="form-control" name="row[policy_no]" type="text" value="{$row.policy_no}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Policynolist')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-policyNoList" class="form-control " rows="5" name="row[policyNoList]" cols="50">{$row.policyNoList}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Commission_owner')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-commission_owner" class="form-control" name="row[commission_owner]" type="text" value="{$row.commission_owner}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Seller')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-seller" class="form-control" name="row[seller]" type="text" value="{$row.seller}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Product_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-product_name" class="form-control" name="row[product_name]" type="text" value="{$row.product_name}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Clause_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-clause_name" class="form-control" name="row[clause_name]" type="text" value="{$row.clause_name}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Commission')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-commission" class="form-control" name="row[commission]" type="number" value="{$row.commission}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Payment')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-payment" class="form-control" name="row[payment]" type="text" value="{$row.payment}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Payperm')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-payPerm" class="form-control" name="row[payPerm]" type="text" value="{$row.payPerm}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Expiretime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-expireTime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[expireTime]" type="text" value="{:$row.expireTime?datetime($row.expireTime):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Totalinsured')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-totalInsured" class="form-control" name="row[totalInsured]" type="number" value="{$row.totalInsured}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Totalpremium')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-totalPremium" class="form-control" name="row[totalPremium]" type="number" value="{$row.totalPremium}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Premium')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-premium" class="form-control" name="row[premium]" type="number" value="{$row.premium}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fundaccount_type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-fundAccount_type" class="form-control selectpicker" name="row[fundAccount_type]">
                {foreach name="fundaccountTypeList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.fundAccount_type"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Commission_type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-commission_type" class="form-control" name="row[commission_type]" type="text" value="{$row.commission_type}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Settle_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-settle_status" class="form-control" name="row[settle_status]" type="text" value="{$row.settle_status}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remake')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remake" class="form-control" name="row[remake]" type="text" value="{$row.remake}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pay" class="form-control" name="row[pay]" type="text" value="{$row.pay}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Expires')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-expires" class="form-control" name="row[expires]" type="text" value="{$row.expires}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_freq')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pay_freq" class="form-control" name="row[pay_freq]" type="text" value="{$row.pay_freq}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Insure_data')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-insure_data" class="form-control" name="row[insure_data]" type="text" value="{$row.insure_data}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Creat_date_end')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-creat_date_end" class="form-control" name="row[creat_date_end]" type="text" value="{$row.creat_date_end}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Effective_date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-effective_date" class="form-control" name="row[effective_date]" type="text" value="{$row.effective_date}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="$row.status"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-type" class="form-control selectpicker" name="row[type]">
                {foreach name="typeList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.type"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
